Hyponatremia in Patients Admitted to Intensive Care Unit of a Tertiary Center: A Descriptive Cross-sectional Study.

Introduction: Hyponatremia is one of the common electrolyte abnormalities in intensive care unit settings. Hyponatremia may lead to an increased hospital stay, morbidity and mortality. Hyponatremia can occur due to a variety of iatrogenic as well as part of complex disease processes during hospital admission. The objective of this study was to find the prevalence of hyponatremia in patients admitted to the intensive care unit of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the intensive care unit of a tertiary care centre for a duration of six months from 12 August 2015 to 11 January 2016. Ethical approval was taken from the Institutional Review Committee (Reference number: 124/6-11-E/072/073). Data was collected from hospital records. Patients with abnormal serum sodium levels after admission to the intensive care unit were included in the study. Hyponatremia was defined as a serum sodium level less than 135 mEq/L. Convenience sampling methods were used. Point estimate and 95% Confidence Interval were calculated. Results: Among 102 patients, the prevalence of hyponatremia was found to be 21 (20.59%) (12.74-28.44, 95% Confidence Interval). Conclusions: The prevalence of hyponatremia in patients admitted to the intensive care unit was higher than in other studies conducted in similar settings. Keywords: cross-sectional study; prevalence; sodium.

Prevalence of Repeat Cesarean Section in a Tertiary Care Hospital.

INTRODUCTION: Cesarean section is the surgical delivery of a baby through an incision made in the mother's abdomen and uterus. Repeat cesarean section has recently increased, partly because of concern about increased risk of uterine rupture in women attempting vaginal birth after cesarean delivery. Among the women who underwent cesarean section in their first delivery, 80-96% had a second surgical delivery. Therefore, the present study aimed to describe the prevalence of repeat cesarean section among Nepali women presented at Kathmandu Medical College and Teaching Hospital who had a previous cesarean section. METHODS: This was a descriptive cross-sectional study conducted in Kathmandu Medical College and Teaching Hospital from 1st of February to 31st of May 2020. Ethical approval was taken from the Institutional Review Committee of the Kathmandu Medical College. Convenient sampling was done. All pregnant patients between gestational ages of 37-40 weeks with previous cesarean section admitted for safe confinement were included in the study. RESULTS: Among the 104 women, who had prior cesarean section, 99 (95.19%) had second cesarean section and 5 (4.81%) had vaginal birth after cesarean. The most common indication for the first cesarean section was fetal distress 31 (29.81%) while the indication for the second cesarean section among previously cesarean section women was cephalo pelvic disproportion 39 (39.40%). CONCLUSIONS: The proportion of cesarean section in both first and subsequent delivery is quite high. This high rate may compromise the reproductive future of the women who underwent consecutive cesarean section with possible consequent complications.

Abnormal Fetal Echocardiography in Diabetic Pregnant Women at a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: The sedentary lifestyle of women and change in their food habits has a significant role in developing diabetes in pregnancies. This leads to an increased chance of fetal cardiac abnormality born by a mother with gestational diabetes and pre-existing diabetes. The objective of the study is to find out the prevalence of abnormal fetal echocardiography in gestational and pre-existing diabetic pregnant women at a tertiary care hospital. METHODS: A descriptive cross-sectional study was conducted among 104 diabetic pregnant women in a tertiary care hospital from April 15, 2017, to April 14, 2018. Ethical approval was obtained from the institutional review committee. The convenient sampling method was used. The patients who were diagnosed as gestational diabetes and diabetic before pregnancy were included in the study. Fetal echocardiography was mainly done at a gestational age of 22-32 weeks depending upon the time of diagnosis of gestational diabetes and for pre-diabetic women, fetal echocardiography was done at 24-26 weeks of gestation. Statistical analysis was done using the Statistical Package of the Social Sciences version 20. RESULTS: Among 104 patients, 16 (15.38%) patients had abnormal fetal echocardiography. Eighty-three (79.81%) were gestational diabetics, 21 (20.19%) were pre-existing diabetic women. Among 83 gestational diabetes, 7 (8.4%) had abnormal echo finding and among 21 pre-existing diabetics, 9 (42.8%) had abnormal echo finding. CONCLUSIONS: There was an increased chance of fetal cardiac malformation in gestational diabetic and pre-existing diabetics diabetic especially in an uncontrolled glycemic state. And, if they were diagnosed prenatally, clinical outcomes for both mother and fetus would have been better.

A Statement of Solidarity on COVID-19 Pandemic 2020 by the South Asian Family Physicians.

The World Organization of Family Doctors (WONCA) is a not-for-profit organization and was founded in 1972 by member organizations in 18 countries. WONCA now has 118 Member Organizations in 131 countries and territories with a membership of about 500,000 family doctors and more than 90 percent of the world's population. WONCA has seven regions, each of which has its own regional Council and run their own regional activities including conferences. WONCA South Asia Region is constituted by the national academies and colleges and academic member organizations of this region namely India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, and the Maldives. In the background of the ongoing COVID 19 pandemic, the office bearers, academic leaders, practitioners, and researchers of primary care from the South Asia Region have issued a solidarity statement articulating the role of primary care physicians.

Preparedness for Coronavirus Disease in Hospitals of Nepal: A Nationwide Survey.

INTRODUCTION: Coronavirus disease pandemic has affected large number of people globally and has continued to spread. Preparedness of individual nations and the hospitals is important to effectively deal with the surge of cases. We aimed to obtain nation wide data from Nepal, about hospital preparedness for COVID-19. METHODS: Online questionnaire was prepared in accordance with the Center for Disease Control recommendations to assess preparedness of hospitals for COVID-19. The questionnaire was circulated to the over 800 doctors across the nation, who are the life members of six medical societies. RESULTS: We obtained 131 completed responses from all seven provinces. Majority of respondents had anaesthesiology as the primary specialty. Only 52 (39.7%) participants mentioned that their hospital had policy to receive suspected or proven cases with COVID-19. Presence of isolation ward was mentioned by 83 (63.4%) respondents, with only 9 (6.9%)mentioning the presence of airborne isolation. Supply of personal protective equipment (PPE) was inadequate as per 124 (94.7%) respondents. Critical care services for COVID-19 patients were possible only in hospitals of 42 (32.1%)respondents. RT-polymerase chain reaction could be performed only in the hospital of 6 (4.6%) respondents. CONCLUSIONS: It is apparent that most of the hospitals are not well prepared for management of patients with COVID-19. Resource allocation and policy making should be aimed to enhance national preparedness for the pandemic.

Medical Induction for Mid trimester Abortion: A Hospital-based Descriptive Cross-sectional Study.

INTRODUCTION: Second trimester abortion is known as termination of pregnancy from 13- 28 weeks of gestation which can be further divided into early second trimester as 13-22 weeks and late as 23-28 weeks. In our study we have limited up to early second trimester. We intend to see the success rate of combination of mifepristone and misoprostol for medical induction, median time required for expulsion, complication and need of dilation and evacuation in some cases. This study also aims to give a review of current literature in mid trimester abortion with respect to efficacy, complication and also to provide evidencebase recommendation for safe regimens for mid trimester pregnancy termination. METHODS: This was hospital-based descriptive cross-sectional study conducted among 40 pregnant women at second trimester admitted for termination of pregnancy in Kathmandu medical collage teaching hospital for the period of six month. Ethical approval was taken from the Institutional Review Committee of Kathmandu Medical College (Ref: 2207202002). Convenient sampling was done. All the pregnant women who need to terminate their pregnancy at second trimester (13-22 weeks) were admitted at Kathmandu Medical College Teaching hospital for termination of pregnancy were included in the study. RESULTS: Among the 40 women, who had termination of pregnancy at second trimester 37 (92.5%) had successful medical termination whereas 3 (7.5%) needed dilatation and evacuation. CONCLUSIONS: The combination of Mifepristone and Misoprostol have excellent result for termination of pregnancy if appropriately used after evaluating the patient with minimal complications.

Ethics in humanitarian services: report on the earthquake in Nepal.

The Nepal earthquake was one of the biggest natural calamities of the year 2015. This paper attempts to explore the ethical issues involved in the humanitarian services rendered during the crisis and thereafter. The four principles of biomedical ethics - autonomy, beneficence, non-maleficence, and justice - are discussed in relation to the relief activities immediately following the disaster and the subsequent long-term activities, such as rehabilitation, wherever applicable. The discussion touches upon public health components such as vulnerable populations, environmental ethics and justice for the future. Incorporating ethical principles into the response to disasters is of vital importance to ensure that healthcare complies with professional norms and ethical standards, and is in tune with the medical needs of the local culture. Beneficence is prioritised, while non-maleficence and autonomy tend to be ignored. Justice, particularly distributive justice, deserves due attention in the context of limited resources, not only during the emergency phase but also during the phases of rehabilitation and planning for the future.